ARTHRITIS

Summary

The veteran, who served from August 1991 to August 2001, including service in the Southwest Asia theater during the Persian Gulf War, appeals the denial of service connection for right hand arthritis and the remand of left hand arthritis. The veteran has a current diagnosis of bilateral hand arthritis, with service treatment records indicating an in-service injury to the left index finger. However, for the right hand arthritis, the Board found no evidence of a diagnosis during service or within a presumptive period, nor continuity of symptomatology. While radiology noted mild degenerative joint disease in the right thumb years after service, it was outside the presumptive period and not linked to an in-service event. The Board determined a VA examination was not necessary for the right hand claim due to the lack of nexus evidence. For the left hand arthritis, the Board found evidence of a current disability and an in-service injury to the left finger, remanding the claim for a VA examination and opinion to determine the nexus to service, including consideration of the veteran's lay statements.

Rationale

No in-service diagnosis or presumptive manifestation; No continuity of symptomatology established; No nexus to in-service injury or event

Full Decision Text

Citation Nr: A26032700
Decision Date: 04/08/26	Archive Date: 04/08/26

DOCKET NO. 210819-180428
DATE: April 8, 2026

ORDER

Entitlement to service connection for right hand arthritis is denied.

REMANDED

Entitlement to service connection for left hand arthritis is remanded.

FINDING OF FACT

The Veteran's right hand arthritis was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease.

CONCLUSION OF LAW

The criteria for service connection for right hand arthritis are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from August 1991 to August 2001, to include service in the Southwest Asia theater of operations during the Persian Gulf War.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2021 rating decision by a Department of Veterans Affairs (VA) regional office, which is the agency of original jurisdiction (AOJ). In the August 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. 

On March 6, 2025, the Veteran withdrew the hearing request. 03/06/2025 Third Party Correspondence. Therefore, the Board may only consider the evidence of record at the time of the June 2021 AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Below, the Board references evidence submitted on May 24, 2024, outside the evidence window described above. However, because the Veteran's representative referenced this evidence in an April 7, 2025, brief, the Board finds it has been "submitted" during the evidence window following the hearing cancellation and may be considered. Cash v. Collins, 166 F.4th 1046 (Fed. Cir. 2026).

Additionally, while the Veteran claimed service connection for bilateral hand arthritis, the Board has bifurcated the matter into two separate issues so they may be properly addressed.

Entitlement to service connection for right hand arthritis

The Veteran contends that he should be awarded service connection for right hand arthritis. 

Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 
38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

The Veteran has a current diagnosis of bilateral hand arthritis as evidenced by a June 2021 rheumatology record. 05/24/2024 Medical Treatment Record - Non-Government Facility. Arthritis is an enumerated condition under 38 C.F.R. e§ 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. July 2013 x-rays of the hands showed mild degenerative joint disease of the right thumb, but were otherwise normal. 08/15/2014 C&P Examination. There is no evidence of a diagnosis of right hand arthritis prior to that date, which is several years outside of the applicable presumptive period. 

While the Veteran is competent to report the onset and course of his symptoms, in this case he has not explicitly alleged that his symptoms began in service. The Veteran's representative argued that "report of a continuity of symptomatology can satisfy the requirement for evidence that the claimed disability may be related to service." 04/07/2025 Third Party Correspondence. This assertion is correct; however, the Veteran has not provided any information regarding continuity of right hand arthritis symptoms since service. In any event, the Veteran is not competent to provide a diagnosis of arthritis or to determine that these symptoms were manifestations of arthritis as he has not demonstrated the necessary medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Accordingly, service connection cannot be granted on a presumptive basis.

Service connection for right hand arthritis may still be granted on a direct basis; however, the evidence of record persuasively weighs against finding that a medical nexus exists between the Veteran's arthritis and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. 

The Board is cognizant that the Veteran has not been afforded a VA examination in connection with his claim for service connection. Generally, a VA medical examination or opinion is necessary when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the veteran qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for VA to make a decision on the claim. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006).

The record reflects a diagnosis of right hand arthritis, but the Veteran has offered no argument as to how the disability is related to his military service, nor is there any evidence of a nexus to service. Service treatment records do not reflect complaints of or treatment for right hand pain or an in-service-injury to the right hand. In that regard, the Board notes there is radiology "Procedure Worksheet" from October 1997 which indicates that the Veteran injured his right index finger. 04/19/2001 STR - Medical. However, this appears to have been a typographical error, as there is a fully documented injury to the left index finger the same day. Id. Accordingly, the McLendon standard is not met
 (2006).

The record reflects a diagnosis of right hand arthritis, but the Veteran has offered no argument as to how the disability is related to his military service, nor is there any evidence of a nexus to service. Service treatment records do not reflect complaints of or treatment for right hand pain or an in-service-injury to the right hand. In that regard, the Board notes there is radiology "Procedure Worksheet" from October 1997 which indicates that the Veteran injured his right index finger. 04/19/2001 STR - Medical. However, this appears to have been a typographical error, as there is a fully documented injury to the left index finger the same day. Id. Accordingly, the McLendon standard is not met and it is not necessary to provide the Veteran with a VA examination of the right hand at this time. 38 C.F.R. § 3.159(c)(4)(i).

In the absence of any competent evidence of an in-service event or injury or that the Veteran's right hand arthritis is related to service, beyond the filing of a claim of service connection, the Board finds that the evidence weighs persuasively against a finding that service connection is warranted. Accordingly, there is no benefit of the doubt to resolve in the Veteran's favor and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

REASONS FOR REMAND

Entitlement to service connection for left hand arthritis

The Veteran asserts that he should be awarded service connection for left hand arthritis. As noted above, the record reflects a diagnosis of bilateral hand arthritis. Additionally, service treatment records show in-service injuries to the left little and index fingers. 04/09/2001 STR - Medical. As there is evidence of a current disability and an in-service injury, the Board finds the failure to obtain a VA examination and opinion was a predecisional error in the duty to assist. Accordingly, remand is required so that a VA examination and opinion may be provided.

The matter is REMANDED for the following action:

Schedule the Veteran for a VA examination to determine whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any current disability of the left hand, to include arthritis, had onset during or within one year of separation from service or is otherwise related to an in-service injury, event, or disease, to include the documented left finger injuries.

In offering the opinion, the examiner is asked to explicitly consider any lay statements of the Veteran regarding the onset and course of his symptoms.

The examiner should elicit a full history from the Veteran and consider the lay statements of record. The Veteran is competent to attest to factual matters of which he has first-hand knowledge, and if there is a medical basis to support or doubt the history provided by the Veteran the examiner should provide a fully reasoned explanation. 

A rationale for all opinions expressed is requested as adjudicators are precluded from making any medical findings.

 

 

M. MILLS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. Bruce, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.